Upheld: Travel / life insurance claim disputes complaint against Casualty & General Insurance Company (Europe) Ltd

Decision detail

Summary

Ms N purchased pet insurance in August 2024 and claimed for veterinary fees to remove a mass from her dog in July 2025. The insurer declined the claim as a pre-existing condition, noting the mass had existed since 2021. Ms N argued the mass appeared harmless, had never required veterinary attention, and only became concerning when it changed in appearance. The ombudsman upheld the complaint, finding it unfair to apply the pre-existing condition exclusion where the policyholder had no reason to believe treatment would be needed at the time of purchase. The insurer was directed to pay the claim with interest and £150 compensation.

The Ombudsman's reasoning

Although the mass technically met the policy definition of a pre-existing condition, it would not be fair to apply the exclusion strictly. Ms N was aware of the mass but it appeared harmless, caused no issues, and she had no reason to believe it would require treatment when she purchased the policy. The mass only became a concern when it suddenly changed in appearance almost a year after the policy started. To fairly decline a claim on pre-existing condition grounds, the policyholder would need to know there was something wrong likely to need investigation or treatment, which was not the case here.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website